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Everything You Need to Know About Concussions

By DR. JASON BRUCKER

Suffering a concussion can be a frightening experience. Although there's been increased attention paid to this type of head injury, especially in sports, understanding the fundamentals and management of concussions can still be challenging. Here are answers to some of the most common questions about concussions:

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What exactly is a concussion?
A concussion (also known as a mild traumatic brain injury) is caused by a direct blow to the head or indirect forces transmitted to the head that cause the brain to hit the inside of the skull. This results in a temporary neurologic disturbance with a wide array of potential symptoms.

Can I get one from a knock on the head?
Yes, although it is not yet clear how much force one would have to sustain to cause a concussion. However, concussions can also be caused without direct impact to the head. Any rapid change in velocity (i.e., deceleration) can cause injury to the brain. Concussions can occur as a result of a fall, car accident or during a physical activity like sports.

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If I don't pass out, is it still a concussion?
Yes, it can be. In fact, some individuals can appear unaffected at first. But keep in mind that some symptoms may take up to several hours to develop. Any loss of consciousness should not be ignored and may require immediate medical attention.

What are the symptoms?
Concussion symptoms often vary between individuals and can manifest both physically and mentally. A headache is one of the more common initial symptoms. Other common symptoms include dizziness or balance changes, nausea or vomiting, sensitivity to light or noise, confusion, problems with short-term memory and difficulty sleeping.

How is a concussion diagnosed?
There are no blood tests or routine imaging tests (including CT scans or MRIs) that can detect a concussion at this time, so the diagnosis needs to be made by a trained professional like a physician.

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An athletic trainer or coach versed in concussions can initiate an assessment on the sideline immediately after the injury using an approved test, such as the Sport Concussion Assessment Tool (SCAT), but this alone is not a replacement for a complete evaluation by a licensed health care provider.

When should I see a doctor or go to the ER?
You shouldn't hesitate to seek immediate medical attention if there's any concern of a more serious injury. After any head injury, a period of monitoring is important to catch any delayed onset of symptoms, including increased drowsiness, slurred speech, vision changes, severe/worsening headaches or neck pain and changes in level of arousal. This could signal a traumatic brain injury, such as bleeding in the brain or a fracture, and could have life-threatening consequences if not addressed in a timely fashion.

What if I am not sure I had a concussion?
It is not always clear immediately if you have a concussion. Nevertheless, an athlete should never return to the game or activity that day if a concussion is suspected. Remember the adage: "When in doubt, sit it out."

How can I prevent a concussion?
Aside from avoidance of high-risk physical activities altogether, there are no specific strategies to prevent a concussion. Be wary of any diet, medications, protective equipment or mouth guards that make claims of concussion prevention. In contact sports like football and hockey, use of specially designed helmets is being investigated, but they have not yet been shown to reduce or prevent concussion. Rather, proper tackling or body-checking techniques may be effective in reducing head-injury occurrence.

How is a concussion treated?
Rest, rest and more rest. A concussion is often described as an "energy crisis" because the brain's metabolism is affected, so it's important to decrease the amount of external stimuli we encounter on a daily basis. This includes school or work, multimedia use (including TV, computer and phones) and physical activity.

How long does it take to recover from a concussion?
The amount of recovery time varies from person to person, averaging around three to four weeks for uncomplicated cases. Recovery time often is prolonged in older individuals as well as those with other medical issues (e.g., chronic headaches) or other sustained injuries (e.g., whiplash). Symptoms will also be prolonged if steps are not taken to rest the brain.

Your clinician will develop a plan to gradually acclimate you back to school or work, followed by a stepwise return to physical activity and sports as your symptoms improve. It's very important to not push through your symptoms and return to activity too early, as this will only delay your recovery.

What are the potential long-term effects of repeated concussions?The effect of multiple concussions on the brain is not fully understood. There's been research and high-profile cases implicating concussion as a potential contributor to certain neurologic diseases, such as chronic traumatic encephalopathy (CTE), amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) and depression disorders.

However, at this time there is no specific recommendation to disqualify an athlete from returning to a sport following recovery from a concussion. The decision should instead be tailored to the individual's situation.

--Dr. Brucker

Readers -- Have you ever experienced a concussion? Were your symptoms similar to those described above? Did you experience any lasting aftereffects? What steps did your health care provider tell you to follow during recovery? Did you find this article helpful? Leave a comment below and let us know.

Jason Brucker, M.D., is an assistant professor of primary care sports medicine in the Department of Orthopaedic Surgery at NYU Langone Medical Center. Dr. Brucker is a sports-medicine physician with an additional background in rheumatology. He has expertise in nonsurgical treatment of orthopaedic and sports-related musculoskeletal injuries, concussion management, arthritis conditions and all medical issues related to sports participation. He evaluates patients at the NYU Langone Concussion Center, the NYU Langone Center for Musculoskeletal Care and the Preston Robert Tisch Center for Men's Health.

 

References:
Harmon KG, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013 Jan;47(1):15-26.

Concussion Center at NYU Langone. Available at http://concussion.med.nyu.edu/, Accessed Dec 29, 2014.

Concussion and Mild TBI. Available at http://www.cdc.gov/concussion/, Accessed Dec 29, 2014.

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